2017 年第 2 期 第 15 卷

晚期非小细胞肺癌中淋巴结转移与EGFR突变的相关性及对患者预后的影响

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关键词：淋巴结转移EGFR突变M分期晚期非小细胞肺癌预后。

• 摘要：
• 【摘要】目的 探索晚期非小细胞肺癌中淋巴结转移与EGFR突变状态的相关性及对患者总生存的预测价值。方法 回顾性分析2007年1月至2014年12月间惠州市中心人民医院收治的1358例晚期非小细胞肺癌患者的临床病理和随访资料，Kaplan-Meier法进行疾病总生存率（overall survival，OS）分析并采用Log-rank检验进行比较。结果 1358例非小细胞肺癌中N0-1患者325例（24%），N2-3患者1033例（76%）。淋巴结转移阴性或仅有肺门淋巴结转移患者（N0-1）多为从不吸烟、EGFR突变型及M1a型患者。 Kaplan-Meier生存分析结果显示，N0-1组患者总生存时间显著长于N2-3组患者。按EGFR因素分层分析显示N0-1/EGFR突变型患者预后最好，N2-3/EGFR野生型患者预后最差，而N0-1/EGFR野生型与N2-3/EGFR突变型患者生存时间类似，处于上述二者之间；按M分期分层提示N0-1M1a患者预后最好，N2-3M1b患者预后最差，而N0-1M1b与N2-3M1a患者生存时间类似，处于上述二者之间。结论 非小细胞肺癌中淋巴结分期与EGFR突变状态显著相关，N0-1患者预后显著优于N2-3患者，同时EGFR状态及M分期可进一步影响上述两组患者的预后。
• Objective To explore t he correlation of lymph node metastasis with EGFR mutation and its predictive value of overall survival in patients of advanced non-small cell carcinoma (NSCLC). Methods A total of 1358 advanced NSCLC patients with long term follow-up from January 200 7 to December 2014 in Center of Huizhou City People’s Hospital were retrospectively analyzed in our study. Kaplan-Meier survival curve was used to analyze overall survival (OS) and Log-rank test was used to calculate P values. Results A total of 1358 NSCLC were divided into two groups: 325 patients (24%) with N0-1 staging and 1033 patients ( 76%) with N2-3 staging . Stage N0-1 was mostly presented in those patients who are nonsmoker, with EGFR mutation or at the stage of M1a. There was remarkable prolonged OS in the group of N0-1 than N2-3 analyzed by Kaplan-Meier survival curve. Based on EGFR mutational status stratification, the group of N0-1/EGFR+ showed the favorable prognosis, while the group of N2-3/EGFR- demonstrated worse prognosis, however, there was no significant difference between the group of N0-1/EGFR- and N2-3/EGFR+. Based on M staging stratification, the group of N0-1M1a showed the favorable prognosis, while the group of N2-3M1b demonstrated worse prognosis, however, there was no significant difference between the group of N0-1M1 b and N 2-3M1a. Conclusion There was significant correlation between N staging and EGFR mutational status in advanced NSCLC patients. Those with an early N staging (N0-1) patients seem to show a better overall survival than those with a late N staging (N 2-3). Meanwhile, EGFR status and M staging could also affect the prognosis between the two groups.